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Blue Shield Health Savings PlanLaura MorganUCSB Human Resources, Benefits

This presentation is intended for communication purposes only. Please see plan document and http://atyourservice.ucop.edu for complete information.

Big changes New choices

11/2013

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Topics• Open Enrollment Overview• Blue Shield PPO• Health Savings Account

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Open Enrollment • Ends Tuesday, November 26, 5:00

pm

• Make changes onlinehttp://atyourservice.ucop.edu

• All changes are effective January 1, 2014

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Actions• Change medical and/or dental plan• Enroll in medical, dental, vision• Add eligible family members• Enroll or re-enroll in Health Flexible

Spending Account (FSA) ◊ unless you select the Blue Shield Health

Saving Plan)• Enroll or re-enroll in Dependent Care

FSA

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2014 Medical Plans2013 2014

Anthem PPO UC Care PPO(administered by Blue Shield)Anthem PLUS

Anthem HRA-PPOBlue Shield

Health Savings Plan (PPO)

Health Net Blue & Gold HMO Health Net Blue & Gold

HMOHealth Net HMO

Kaiser HMO Kaiser HMOCore Core

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Default Medical Plans2013 Medical Plan 2014 Medical Plan

Health Net Blue & Gold HMO

Health Net Blue & Gold HMO

Health Net HMO (full) Health Net Blue & Gold HMOKaiser HMO Kaiser HMOAnthem PLUS UC Care Anthem PPO UC CareAnthem Lumenos HRA Blue Shield Health Savings

PlanAnthem Core Blue Shield Core

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What is your priority?• Cost to enroll – monthly premium• Cost of care

◊ Predictable, low cost copays◊ Pay a % of each service

• Choice of providers◊ HMO medical group physicians◊ PPO preferred network or any provider

• Effort to manage – coordinating care & bills

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Blue Shield Health Savings Plan

Combines high deductible PPO with account to pay out-of-pocket expenses

Medical CoverageBlue Shield PPO

Health Savings AccountHealthEquity

+

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Lumenos vs Blue Shield HSP

Deductible Health

Reimbursement Account (HRA)

Member pays

PPO Coinsurance

Lumenos Blue Shield PPODeductible Member pays

PPO Coinsurance

UC ContributionsMember ContributionsLumenos HRA Rollover

Health Savings Account

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Preventive Care• Preventive care is covered at 100%

with Blue Shield PPO providers• Preventive care includes:

◊ Annual well visit and labs◊ Well woman visits and labs◊ Preventive screening tests◊ Immunizations

• See list of preventive services on http://www.blueshieldca.com/uc

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Blue Shield PPO• You direct your own care, you decide

where to receive services• You pay annual deductibles before plan

pays• After deductible, you share the cost of

each service with the plan - coinsurance• Your costs are lower if you select a Blue

Shield PPO provider• “Out-of-pocket Maximum” limits your

financial liability

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Residence, Networks & Travel

• The employee must live in US• When in US

◊ Comprehensive coverage◊ Blue Shield PPO network in CA◊ Blue Cross Blue Shield network outside

CA• When traveling out of US

◊ Emergency and urgent care only◊ NO routine care

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Blue Shield PPO - Plan Design

In Network Out of Network

Deductible Single Family

$1,250$2,500

$2,500 $5,000

Member Cost Sharing(Coinsurance for medical and drugs)

20% 40%

Out-of-Pocket Max(includes deductible) Single Family

$4,000 $6,400

$8,000 $16,000

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Single vs FamilySame design as Lumenos:

• Single = one person enrolled in plan

• Family = more than one person in plan◊ Families share one deductible◊ Families share one out-of-pocket

maximum

(UC Care has a different plan design)

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Deductible, Coinsurance, OOPM

You pay You share cost with plan

Plan pays100%

$1250Deductibl

e20% Coinsurance $4000

OOPM

Blue Shield Health Savings Plan Individual (Single)

Preferred Providers

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Deductible, Coinsurance, OOPM

You pay You share cost with plan

Plan pays100%

$2500Deductibl

e20% Coinsurance $6400

OOPM

Blue Shield Health Savings Plan Family

Preferred Providers The full family deductible must be met before plan

shares costs

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Allowed Amount – In Network

In-Network ExampleDiscounted rate that plan negotiates for each service with “preferred” or participating providers• You pay the in-network

coinsurance on the discounted rate.

• Provider can’t “balance bill”

20% Coinsurance

Provider charge: $200Allowed amount: $100Plan pays 80%: $80You pay 20% $20

Provider write-off:$100

PPO plans negotiate “allowed” rates to process claims.

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Allowed Amount – Out of Network

Out-of-Network ExampleValue that plan assigns to a service when provider is NOT a “preferred provider” (not participating)• Plan pays out-of-network

coinsurance on the allowed amount.

• Provider can “balance bill”

40% Coinsurance

Provider charge: $200Allowed amount: $100Plan pays 60%: $60(60% of $100)You pay 40%: $40You pay balance: $100

PPO plans assign “allowed” rates to process claims.

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Medical Claims, EOBs & Bills

You receive servicesYou pay nothing at the time of service for in-network care

Provider sends claim for services to Blue Shield

Blue Shield sends EOBExplanation of Benefits (EOB) outlines allowed charges, deductible and co-insurance. “This is not a bill”.

Provider sends billThe bill should match the EOB. It should reflect the in-network discount and any payments received from health plan.

You pay provider• Pay with HSA fundsor• Pay with other funds

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Prescription Drugs• There is no separate drug plan with

copays• Drug expenses are applied to the plan

in the same way as medical expenses◊ You pay full cost of medication until you

satisfy the deductible◊ After deductible, you pay 20% at

preferred pharmacies

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Pharmacy ClaimsYou go to the pharmacy

Pay with your HSA debit cardorPay with personal funds and later go to your HealthEquity account online and reimburse yourself (if you have money in the account)

Give pharmacist your Blue Shield ID card so they can apply the Blue Shield Rx discount

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Learn more about PPOsFair Health Consumerhttp://www.fairhealthconsumer.org/• Estimate cost of medical procedures• “LEARN” tab – print and video resources

◊ How plans work◊ Cost Sharing, know what you may owe

Good Rx• http://www.goodrx.com• Estimate cost of drugs (for Blue Shield

HSP)

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Health Saving Account

Blue Shield PPO +

High deductible medical plan paired with a Health Savings Account

Health Savings Account

• The Health Savings Account is not a component of the medical plan as HRA is with Lumenos.

• It is a separate account that can be used to pay medical and other health expenses.

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Why is HSA better?• You keep the money even if you change

jobs or insurance plans• You can make contributions at any time• It has triple tax advantage

• No Federal taxes on contributions • No taxes when funds are used• No taxes on earnings

• HSA funds rollover from year to year; no use it or lose it as with Health FSA

Employees can maximize savings

• UC Contribution (1/1/14) ◊ $500 individual ◊ $1000 family

• You can contribute up to (optional): ◊ Single-coverage: $2,800 ◊ Family-coverage: $5,550◊ Catch-up contribution, age 55+:

$1,000Tip: Contribute the money you would

have put in your Health FSA.

Who is eligible for HSA?To own an HSA you need to:• Be covered ONLY by an HSA-qualified

health plan◊ Other health coverage may disqualify you,

including Health FSA, Medicare or traditional health plan

◊ Health FSA must have a $0 balance on Dec. 31, 2013 (complete any claims reimbursement by Dec. 31, 2013)

• Not be claimed as a dependent on someone else’s tax return

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Your Responsibility• Contribute only the amount allowed

by IRS• Use HSA funds for eligible expenses• Keep itemized receipts as tax

documents• Follow HSA eligibility rules

Lumenos HRA Rollover• Remaining Lumenos HRA money will roll-over

into the Health Savings Account (4/1/14)• Lumenos HRA $ are treated differently than

HSA $ by IRS• Lumenos HRA $ becomes a “Post Deductible

Health Reimbursement Account” = PDHRA• You must pay the Blue Shield HSP deductible

with other funds BEFORE you can use the PDHRA to pay eligible expenses.

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Example: Lumenos PDHRA • Single Deductible $1,250• UC Contribution to HSA $500• Remaining balance $750

◊ Pay with personal fundsorPay with your contributions to HSA

• Lumenos PDHRA can be used to pay 20% coinsurance after deductible is satisfied

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Use the HSA to pay for…• Deductible• Coinsurance• Any IRS Publication 502 Expenses, including:

◊ Medical◊ Dental◊ Vision◊ Prescription drug◊ Long Term Care insurance premiums

• See Health Equity website for more information

How does HSA work?• UC makes annual contribution for plans

that start on January 1.• You may contribute through payroll

deduction or make post-tax contributions to HealthEquity

• Use a HSA debit card to pay for health expenses

• Use HealthEquity website to pay medical and other health claims

• Invest HSA dollars when account balance reaches $2000 – no fees to invest

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HSA vs FSA• The HSA is NOT like the Health FSA where

you have access to the entire annual contribution starting on January 1

• The HSA is like a checking account – the money must be in the account before you can spend it◊ You make monthly contributions

through payroll deduction, you can change the contribution amount during the year

◊ You can make one time contributions through Health Equity

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www.healthequity.com/ed/uc

Register as new member on this site after 1/1/14

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www.blueshieldca.com/uc Register as new member on this site after 1/1/14

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Health Equity Member Portal

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Claim Summary Screen• View claim detail• Choose action to

be taken − Pay provider− Reimburse

themselves− Close

expense• Pay from HSA

account or external checking/savings account

• Schedule payment

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Member Resources• Welcome Kit - to get you started• Debit card loaded with UC

Contribution• Online resources

◊ Treatment cost estimator tool◊ Drug costs, information and claim

summary• Smart phone browser

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Optum (formerly United Behavioral Health)

• Optum coordinates behavioral health care for all medical plans (except CORE)◊ psychiatrist◊ psychologist◊ therapist◊ substance abuse treatment

• No referral required from physician• Call Optum to notify prior to first visit

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Behavioral/Mental Health• Medical and behavioral health deductibles and

OOPM cross accumulate.• See the Evidence of Coverage for complete

details. Covered Service

Optum Clinicians

Out-of-Network

Deductible $1,250 individual$2,500 family

$2,500 individual$5,000 family

Outpatient Office Visits

You pay 20% Plan pays 60% of allowed rate

Emergency Room

You pay 20% Plan pays 80% of allowed rate

Inpatient Stays You pay 20% Plan pays 60% of allowed rate

For more informationHealthEquity Member Services is available

every hour of every dayCall the Blue Shield/UC dedicated line

1.855.201.8375 say

“Health Savings Account”

www.healthequity.com/ed/uc

www.blueshieldca.com/uc

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http://atyourservice.ucop.edu/oe

• Resources◊ Plan contacts◊ Plan rates

• Medical Plans◊ Benefit summaries◊ Links to plan websites◊ Links to provider directories

• Other plans◊ Dental, vision, FSA

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Two Adults – Payband 51K-101KUC Care 281/moHSP 103/moDifference 178 x 12 = 2,136

Family Deductible 2,500Premium Saving 2,136UC HSA Contribution 1,000

Maximum HSA Contribution 5,550